Marc Darrow MD,JD

Over the years we have seen many patients with Plantar Fasciitis that had been unresponsive to conventional treatments. These conventional treatments included physical therapy, cortisone, and anti-inflammatories. While not the best choice for doctor or patient, many of these people considered the surgical option as the ultimate choice because they “have to do something.” But will surgery be any more effective? We will cover this in research cited later in this article.

Is it the heel spur causing pain or is it plantar fasciitis?

When a patient comes into our office with plantar fasciitis and a bone or heel spur revealed on an x-ray or an MRI, the first thing they want to know is can we get rid of the bone spur? I usually have to do a little convincing that it is usually not the bone spur that is causing them their pain and that heel spur is not the issue we want to tackle at the start of the treatment. I explain to the patient that the issue is that you’re overdoing an activity which is irritating the place where the fascia (the soft tissue that connects the toes to the heel) meets the heel bone. When that irritation is constant and chronic, bone spurs form. We want to treat that problem.

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Marc Darrow MD,JD

I frequently see patients with an MRI of a tendon tear or an MRI of a problem of chronic tendinopathy. Tendinopathy is a more recent term to describe a chronic pathology of a tendon that causes pain. The problem of Tendinopathy can be It is divided into two broad categories:

• Tendinitis means inflammation of the tendon. This is the characteristic swelling that comes with a worsening wear and tear or acute injury.
• Tendinosis is the “old, nagging injury.” The tendon is injured but the body has given up trying to heal it. It is an injury without inflammation. Why did the body give up? In some of the people we see, it comes as the result of a long and extensive anti-inflammatory or cortisone treatment history.

Anti-inflammatory drugs and cortisone injections are effective at reducing pain and inflammation, but do not have a healing effect. Worse, their detrimental effects may lead to complete tendon rupture which usually requires surgical repair. For more on this and supportive research, I invite you to review my articles:

• Systemic effects of corticosteroid injections
• How anti-inflammatories accelerate degenerative knee disease.

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Marc Darrow MD,JD

The hip joint, the shoulder joint, the knee joint, the big toe joints, they all have one thing in common. When they are in the process of wear and tear degenerative joint disease, they become unstable, painful, and they start forming bone spurs and bony overgrowths. Sometimes the person suffering from degenerative joint disease will let this condition of joint instability go on for too long. This will cause the bone spurs to become too large and they will freeze up the joint, making it stiff and unmoveable, and, necessitating a need for surgery to shave down the bones. In the big toe, this bone spur or overgrowth is commonly referred to as a bunion.

In this article I will discuss with you the two main type of patients we see with big toe pain. The patient who has big toe joint instability that can be helped with PRP and stem cell therapy injections and the patient with a large bunion and what we may be able to do for them.

The big toe has two joints

• metatarsophalangeal joint (the bunion joint)
• interphalangeal joint (the joint under the toenail)

The metatarsophalangeal joint is where we will concentrate this article.
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Marc Darrow MD,JD

I receive many emails about accelerating the healing of a surgically repaired tendon with stem cell therapy. These emails come from athletes or people who need to get back to work much faster than their surgical rehabilitation is allowing them to. Generally speaking stem cell therapy can be very successful in augmentation repair of a surgery. Of course each patient is unique and a consultation would be required to come up with a realistic healing program for that patient’s specific goals.

Preferably we would like to see the patient before the surgery to see if stem cell therapy and Platelet Rich Plasma injections can repair the Achilles tendon without the need for surgery. If the patient can avoid a surgery, then the patient can avoid the recovery that surgery requires.

A brief description of our treatments

• PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. Learn more about PRP treatments.
• Stem Cell Therapy is the injection of a damaged area of the body with stem cells that have been drawn from the patient’s own bone marrow. Stem cells are “de-differentiated pluripotent” cells, which means that they continue to divide to create more stem cells; these eventually “morph” into the tissue needing repair — for our purposes, collagen, bone, and cartilage.

These treatments may be effective in partial Achilles tendon tears or strengthening the other structures of the ankle / foot complex.

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